IBCC chapter & cast – Hypoglycemia

Severe hypoglycemia can be scary, especially when the patient isn't responding to front-line therapies (e.g. IV dextrose). However, some unconventional tools and an organized approach can make this extremely manageable.

Hypoglycemia is an often encountered problem in EMS, although with increasing use of insulin pumps the incidence seems to me to be decreasing. EMS is frequently called when the patient becomes unresponsive. These patients often have veins that are very difficult to access, and I often end up accessing a very small vein with a small catheter that will not pass D50. We do not carry D25 or D10 so we have to mix our own. That, however, is not difficult and the easiest concentrations to shoot for are D25 and if necessary D12.5. D12.5 will go thru a 22 ga catheter with relative ease, and can be made by simply “wasting” 350 milliliters from a 500 bag and adding an amp of D50 to the remaining 150 milliliters. While it takes a bit longer to infuse I just keep telling myself that the patient is benefiting from the sugar immediately, it is simply taking a bit longer to achieve responsiveness. On a side note it is interesting the different ways patients come out of hypoglycemic episodes. Some look at you and smile, others can be incredibly violent. If a frequent flyer is of the incredibly violent type we enlist… Read more »

What's Your Job?

CC-paramedic

Vote Up0Vote Down Reply

11 months ago

Guest

Patrick Switzer

Grant, I think there is a fundamental difference between the hypoglycemic / opiod OD presentation in that for the opiod overdose patient, the reduction of LOC happens first, followed by respiratory depression. Therefore, as long as you reverse enough receptors to get the patient spontaneously breathing on their own, you can leave them napping peacefully in safety while transporting to hospital. You can take your time while reversing because you can ventilate the patient with BVM while titrating naloxone.

In the hypoglycemic patient, the reduced LOC happens relatively late in the process, when serum glucose is dangerously low. If you attempt to titrate the glucose to achieve a state of minimal responsiveness you cannot be sure they are out of the brain damage danger zone. The only way to know they are adequately treated is if they wake up, or if your fingerstick or serum glucose has normalized.

I can certainly see your dilemma though- I wouldn’t want to battle with a patient in the field.

What's Your Job?

RN

Vote Up0Vote Down Reply

11 months ago

Guest

Grant Jonsson

Patrick…Thank you for your reply. I wish it had been different, but as Shakespeare once said, “Dem’s da breaks”.

What's Your Job?

CC-paramedic

Vote Up0Vote Down Reply

11 months ago

Guest

Allan

If you waste 300 from a 500 bag and add the amp in, you get 10%. Makes math easier to dose, especially for kids.

What's Your Job?

Paramedic

Vote Up0Vote Down Reply

10 months ago

Guest

Allan

Also, regarding dosing to lethargy; I don’t know if that’s possible. Dextrose isn’t like narcan that the stopping point can accurately predicted. A dangerously low blood sugar usually means unresponsive, it’s not too much higher before confused and feisty happens. I think we’re better off replenishing the glucose and trying to keep everyone safe until they have their faculties again. As you said, it sucks bringing the fuzz in to help restrain, but I cant think of there’s a better way to do it.